Home About Us Contact Us

 

Table of Content - Volume 21 Issue 2 - February 2022


 

Clinical study of cardio vascular manifestations in dengue fever

 

Shankaraapp R S

 

Associate Professor, Department of General Medicine, Sri Siddartha Medical College, Tumakuru, Karnataka, INDIA.

Email: sushishyla62@gmail.com

 

Abstract              Background: Dengue is a mosquito-borne viral disease by Flaviviridae family causing wide spectrum of disease ranging from subclinical disease, severe flu-like symptoms to severe dengue associated with severe bleeding, organ impairment, plasma leakage with higher risk of death when not managed appropriately. WHO classifies earlier as DF/ DHF/DSS, at present as Dengue (with or without warning signs) and Severe Dengue. Cardiovascular manifestations in dengue can range from asymptomatic bradycardia to life threatening myocarditis, pulmonary oedema and shock. Sinus bradycardia, transient ventricular arrhythmias, prolonged PR interval, nonspecific ST segment and T wave changes, and transient atrioventricular blocks are some of the ECG findings that can be seen. The virus can be detected by NS1 antigen, ELISA IgM IgG antibodies. Study is planned in south Karnataka to assess the cardiovascular manifestations of dengue fever and to assess the subclinical cardiac involvement in the form of ECG changes in dengue patients. Aims And Objectives: To study the cardiovascular manifestations including subclinical cardiac involvement in the form of ECG changes in serologically confirmed dengue patients. Material And Methods: Prospective observational study conducted for patients more than 15 years with Dengue NS1Antigen positive or IgM/IgG positive. Detailed clinical history, physical examination and laboratory parameters were recorded in a prescribed proforma after taking consent. Cardiovascular manifestations like tachycardia, bradycardia and hypotension are analyzed in all patients including ECG and recorded the findings. Data was entered in Microsoft Office Excel Sheet 2010 and analyzed. Results: There are 150 serologically positive Dengue out 0f which majority 54% are NS1 positive, 65.4% males and 34.6% females, 68.6% % are in 15-40 age 11.3% in 15-20, 33.3% in 21-30and 24% in 31-40age. Commonest clinical presentations along with fever are Headache 71.3%, myalgia 68.6%, nausea and vomiting 41%, arthralgia27%, Warning signs are abdominal pain 16%, bleeding manifestations 5.3%, restlessness 6.3%, altered sensorium 3.3%. Abnormal laboratory parameters are 82.6% thrombocytopenia with 73.3% having platelet < 1 lakh, leucopenia 37.33%, abnormal renal function tests 33.3%, elevated liver enzymes 24%. Conclusion: Commonly noted Cardiovascular manifestations are sinus bradycardia, hypotension and ECG changes. Commonly noted ECG changes are bradycardia, non-specific ST-T changes and Diffuse 'T' Wave Inversions. Cardiovascular involvement is not uncommon but most requires only supportive management. Early recognition of warning signs and meticulous management reduce the morbidity and mortality of dengue.

Key Words: Cardiac manifestations, ECG, Dengue, Severe Dengue, Warning signs.